title: [Influence of comorbidities and delay in surgical treatment on mortality following femoral neck fracture].
abstract: BACKGROUND
  Hip fractures typically occur in geriatric patients representing an increasing medical as well as socioeconomic challenge.
  
  
  METHODS
  In order to reveal the influence of considerable comorbidities and the time of surgery in the treatment of geriatric hip fractures we analysed patients treated between 1993 and 2008 at a level I trauma centre.
  
  
  RESULTS
  654 patients with isolated hip fractures were included. Surgical treatment was performed with osteosynthetic stabilisation in 55.5 % (n = 363) and with endoprosthetic implants in 44.5 % (n = 291). The presence of pulmonary, psychiatric and metabolic/endocrinological comorbidities resulted in delayed treatment. If an early surgical treatment was performed within the first 12 hours after hospital admission, long-term survival was significantly improved (p = 0.02). A regression analysis revealed a statistical trend towards an increased mortality of 0.2 % per hour delay after hospital admission. The presence of considerable comorbidities and surgical treatment with endoprosthetic implants (odds ratio 1.611) were proven as independent mortality factors.
  
  
  CONCLUSIONS
  The present study supports the guideline of early surgical treatment of geriatric hip fractures. Emphasising the incidence of in-hospital complications and the mortality after endoprosthetic treatment, osteosynthetic fracture stabilisation should be considered in the presence of considerable morbidity and pre-surgical immobilisation.
authors.affiliation: Klinik für Unfall- und Wiederherstellungschirurgie, Universitätsklinikum Aachen.
authors.forename: H
authors.initials: H
authors.lastname: Andruszkow
authors.forename: B
authors.initials: B
authors.lastname: Scharff
authors.forename: A
authors.initials: A
authors.lastname: Zapf
authors.forename: M
authors.initials: M
authors.lastname: Klein
authors.forename: P
authors.initials: P
authors.lastname: Lechler
authors.forename: F
authors.initials: F
authors.lastname: Hildebrand
authors.forename: M
authors.initials: M
authors.lastname: Frink
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005265:Femoral Neck Fractures / Q000401:mortality* / Q000601:surgery*; D015577:Geriatric Assessment / Q000706:statistics & numerical data; D005858:Germany / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008171:Lung Diseases / Q000401:mortality*; D008297:Male; D001523:Mental Disorders / Q000401:mortality*; D008659:Metabolic Diseases / Q000378:metabolism*; D011183:Postoperative Complications / Q000401:mortality*; D012189:Retrospective Studies; D018570:Risk Assessment; D015996:Survival Rate; D016896:Treatment Outcome; D014850:Waiting Lists / Q000401:mortality*